Although it wasn’t our original intention, participation in the CMS physician group practice (PGP) demo retrospectively allowed us to build the medical home, although we didn’t know at the time that we were doing that. Building the clinical model first was a key to the measure of our success in being able to contract with both commercial plans and Medicaid in our area. This project also became the model for reimbursement and for our contracting.

The CMS demonstration consists of 10 multi-specialty groups around the United States. It is only a fee-for-service (FFS) demonstration project in a Medicare environment. The patients are assigned to each of the group practices retrospectively, based on the preponderance of outpatient care that is delivered in that group practice. For example, if a patient has at least 51 percent of outpatient visits in our site, that patient is assigned to us and we are assigned the responsibility for the total cost of that patient’s care. Then, the total cost of the care that we spend or coordinate on the patient’s behalf is compared to the total cost of care to all other Medicare individuals in the area who don’t receive the preponderance of care from us. If we provide the care more cheaply  if the rate of rise of the total cost of care is less than the rate of rise of our comparison group  we are eligible for a bonus, which is 80 percent of the difference between the two groups. That is important because we used that basis when we began talking to the commercial health plans about negotiating a medical home pilot. The bonuses allocated for cost savings first, then for quality. You can get approximately 50 or 60 percent for cost savings and the rest are for very specific pay-for-performance (PFP) design quality metrics.

We had success. We are currently in year five of this initiative. We just received the draft report on year three. In year one we did achieve savings, but we didn’t meet the threshold for a bonus payment, which is 2 percent. We did achieve all of the quality metrics in year one, so we increased quality compared to benchmark. Year two we achieved savings, passed the threshold and achieved 98 percent of the quality metrics, so we received a $6.8 million bonus payout. Part of that payout was for quality. An internal analysis shows that we have also achieved savings in year three and the payment is currently being calculated. Because we participated in this program, we did receive CMS Physician Quality Reporting Initiative (PQRI) payments without having to do additional reporting every year.

Here are some highlights from the medical home build that we achieved by participating in this project. We learned and developed a better way of ICD-9 coding. For a successful medical home, Medicare and we believe that the population that you take care of does need to be risk-adjusted. As the only academic medical center in the area and some of the only subspecialists, we do have some adverse risk selection. We also transformed the role of the nurse into health coaches, previsit planners, care coordinators and outreach workers. We developed registries of our patients, beginning with a disease-focused registry. Then, it became very clear that it needed to become patient-focused. Most of our Medicare diabetics also had some other comorbidity, and rather than having 20 disease registries, we needed to have a patient-focused registry. We developed best practice care processes for chronic diseases and for prevention, and we spread them to all 48 care sites. We began doing post-discharge phone calls for our patients because many of our patients are taken care of in the communities in which they live, not necessarily by ourselves. The transfer and the handoff, as part of the care coordination, became a very important part of the medical home build  so much so that when we began looking for a partner in the commercial world so we could test this model of better, more coordinated care, we already had the clinical infrastructure built.

Good or bad, the Jersey Shore has been getting a lot of press lately, thanks to a hugely popular reality show filmed about 10 miles south of our office. A new report issued last week offers a reality check on the health of residents at the Jersey shore and nationwide. The County Health Rankings, a collaboration of The Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, ranks the overall health of every county in all 50 states after examining its health behaviors, clinical care, social and economic factors and the physical environment.

Interactive maps allow you to drill down to each county, which is ranked within the state on how healthy people are and how long they live. The maps provide an eye-opening look at key factors that affect health, such as smoking, obesity, binge drinking, access to primary care providers, rates of high school graduation, rates of violent crime, air pollution levels, liquor store density, unemployment rates and number of children living in poverty.

Our home base of Monmouth County fares pretty well, receiving an overall rating of 6 out of 21 New Jersey counties. However, there’s room for improvement: we have the highest saturation of binge drinkers in the state (a risk factor for at least 10 adverse health conditions), offer only average access to primary care and could boost the numbers of Medicare enrollees receiving diabetic screenings.

According to the National Multiple Sclerosis (MS) Society, approximately 400,000 Americans and 2.5 million worldwide have MS. Every week, another 200 people are diagnosed. In this week’s issue, discover the link between drinking milk while pregnant and a baby’s risk of MS, as well as new research on blood flow in MS patients.

The WHO has found that of 1.8 billion prescriptions dispensed annually in the U.S., only half are taken correctly by the patient. This week we look at a new program to help California residents reduce the margin for medication error, as well as a best-in-class disease management tool with a module on medication safety.

Also in this issue, learn three simple routines that when used in tandem may significantly trim obesity prevalence in preschoolers.

Tobacco now claims at least 1.3 billion users and kills more than 14,500 people every day, while debilitating and sickening many times that number. In this issue, discover whether cigarette smoking can increase Alzheimer’s disease risk as well as whether stopping smoking benefits lung cancer patients.

On the prevention front, a new report outlines 21 challenges and needs for global tobacco control, and 220 companies describe their smoking cessation programs.

Tobacco now claims at least 1.3 billion users and kills more than 14,500 people every day, while debilitating and sickening many times that number. In this issue, discover whether cigarette smoking can increase Alzheimer’s disease risk as well as whether stopping smoking benefits lung cancer patients.

On the prevention front, a new report outlines 21 challenges and needs for global tobacco control, and 220 companies describe their smoking cessation programs.

More than 40 percent of employees identified their employers as supportive or extremely supportive in seeking care for health issues, according to a survey by the American Psychiatric Association (APA). The national survey also showed that barriers still exist for those employees who said their workplace is unsupportive of employees seeking treatment, especially for mental health treatment. Loss of status at work and concerns about confidentiality were identified more often as barriers to seeking treatment for mental health issues than for other illnesses.

Of these employees, 76 percent thought their status would be impacted for seeking treatment for drug addiction, 73 percent for alcoholism, and 62 percent for depression compared to 55 percent and 54 percent who indicated status as a barrier for diabetes and heart disease treatment.

The APA’s Partnership for Workplace Mental Health offers the following tips for employers who wish to create an environment that encourages employees taking care of their physical and mental health:

1) Lead by example. Supervisors and managers play a crucial role in creating a healthy environment by taking care of themselves. Set the tone and take care of your own health.

3) Discourage people from working while ill. Employees that need to take off time due to an illness should know that their employer wants them back—safely, healthy, and productive.

4) Promote the investment you are already making. Remind employees of the health benefits and programs available to them. Make sure employees know how to access care, including programs like Employee Assistance Programs.

5) Reassure employees about confidentiality—this is especially important for mental health treatment. Remind employees about the ways that their privacy is protected when they utilize services, including Employee Assistance Programs.

Two-thirds of healthcare organizations use telehealth for clinical or non-clinical purposes, according to a 2009 Healthcare Intelligence Network survey. The September 2009 survey also identified the most common applications for telehealth, the prevalence of remote monitoring, benefits and ROI, the greatest barriers to implementation and other telehealth trends among survey respondents.

Conducted online in September 2009, the survey’s goal was to document metrics in the use of telehealth and telemedicine and identify emerging applications of these technologies. Through responses provided by 139 healthcare organizations to 19 multiple choice and open-ended questions, the survey results offer a glimpse into a healthcare future where no patient is left behind because of a lack of access.

Survey Highlights

— Almost three-quarters of respondents  66.9 percent  are using telehealth for clinical or non-clinical purposes.

— Specialist real-time remote diagnostic consultations was the most common application of telehealth by respondents (14.7 percent).

— Almost half of respondents  49.3 percent  monitor the health conditions of some patients or members remotely.

— The telephone is the technology most often utilized in the telehealth initiatives of respondents (72.1 percent).

— Healthcare efficiency is the area most impacted by the introduction of telehealth, report 73.3 percent of respondents.

— Reimbursement has been the greatest barrier to implementation of telehealth, report 19.6 percent of respondents.

Key Findings

Prevalence of Telehealth and Telemedicine:

— Of the remaining 33.1 percent of respondents that do not engage in telehealth, 21.3 percent plan to do so in the next year.

— Private payors are the most common funding source for telehealth efforts, say 40 percent of respondents.

— More than half  57.7 percent  do not know whether their state has passed legislation regarding reimbursement for telehealth.

Telehealth Targets and Delivery:

— A majority of respondents (61.9 percent) direct telehealth programs at their entire population, while 17.5 percent focus only on the chronically ill.

— After remote specialist consults, health information by telephone was the second most frequent application of telehealth (13.2 percent) followed by equal use of telehealth for distance education of patients and providers, EHRs, patient and caregiver e-mails and automated message reminders for appointments and medications (all reported by 10.3 percent).

In spite of President Obama’s plea last week for renewed commitment to healthcare reform, the nation’s priorities appear to be gravitating more toward job creation and budget deficit reduction. Meanwhile, a new Kaiser Family Foundation poll finds that even after a yearlong media blitz, many Americans remain unfamiliar with key elements of the two major healthcare reform bills passed in the House and the Senate. A featured story in this week’s Healthcare Business Weekly Update, the poll also found that while Americans are divided over health reform proposals, many become more supportive after being told about many of the major provisions in the bills.

We also present new data that could help control healthcare costs and utilization among Medicare beneficiaries. Contrary to popular thought, Brown University researchers now believe that increasing co-pays for outpatient visits — at least for senior citizens — may make care far more expensive. They determined that patients faced with higher co-payments did cut back on doctor visits, but ultimately required expensive hospital care because their illnesses worsened. Aetna hopes to avoid this with its user-friendly strategy for heading off high-risk complications among its elderly. Listen to the details in this week’s HealthSounds podcast.

New month, new survey. We’re taking another look this year at the way healthcare uses economic incentives to drive participation and results in health and prevention programs. Complete the survey by February 28 and get a summary of the results.

Download this FREE report for data on the top clinical targets of healthcare case managers; the top means of identifying and stratifying individuals for case management; and the most common locations of embedded or colocated case managers.